The Collaborative for Innovation in Vascular Access (CIVA)

The Collaborative for Innovation in Vascular Access (CIVA) is a multidisciplinary cooperation of vascular access clinicians, researchers and educators from South Western Sydney Local Health District and beyond.

CIVA’s primary goal is to improve the outcomes related to vascular access devices through clinical innovation, education and research.

The group is involved in large international multicentre studies and local studies that include NHMRC funded clinical trials and collaborates with a number of vascular access groups such as The Alliance for Vascular Access Teaching and Research Group (Griffith University), The Australian Vascular Access Society, The Association for Vascular Access (USA) and The World Congress on Vascular Access.

Some of CIVA’s current work include:

Clinical Innovation:

  • Development of a difficult venous access (DiVa) pathway that has been implemented at Liverpool Hospital and a number of hospitals locally and internationally
  • Use of electrocardiography to navigate and place central venous catheters to negate the need for chest  X ray
  • Development of a venous access pathway for the correct choice of vascular access device
  • Development of ultrasound insertion algorithm for the correct device choice for patients with difficult venous access
  • Use of standard and specialised peripheral catheters as extended dwell devices for patients requiring short to intermediate term intravenous therapy


  • Teaching and accreditation of medical students and junior medical officers in venepuncture and cannulation through the University of New South Wales South West Clinical School
  • Presentation to key professional groups on safe vascular access such as the Intensive Care Foundation and the Alliance for Vascular Access Teaching and Research
  • Post graduate unit in vascular access (401241 – Essentials in Vascular Access) offered through the School of Nursing and Midwifery at Western Sydney University.

Research (current projects) :

  • Difficult venous access – the patient experience
  • The one million global peripheral intravenous catheter (OMG PIVC)  study
  • Evaluation of midline catheters for hospital in the home
  • Evaluation of midline catheters for patients requiring short to intermediate antimicrobial therapy
  • Cochrane systematic review on arterial catheter placement
  • Evaluation of extended dwell femorally inserter central catheters (FICCs)
  • Randomised trial on electrocardiographic placement of central venous catheters - P Wave Trial
  • Routine Standard Verses Prolonged use of administration sets (NHMRC) – RSVP Trial
  • Peripherally Inserted Central catheter dressing and Securement (NHMRC) - PISCES Trial
  • The effectiveness of midline catheters in geriatric patients admitted to hospital for intravenous therapy: a randomised control trial.
  • Evaluation of Nurse Led portacath placement in a large oncology hospital in Athens, Greece.

CIVA Publications

Alexandrou, Evan, Spencer, Tim, & Davidson, Patricia. (2008). Nursing central line service prevents catheter related infections. Australian Nursing Journal: ANJ, The, 15(11), 49

Alexandrou, Evan, Frost, Stephen, Spencer, Tim, Davidson, Patricia, Parr, Michael J, & Hillman, Ken M. (2009). Nurse led central venous catheter insertion: An integrative review. Australian Critical Care, 22(1), 61.

Alexandrou, Evan, Spencer, Timothy R, Frost, Steve A, Parr, Michael JA, Davidson, Patricia M, & Hillman, Kenneth M. (2010). A review of the nursing role in central venous cannulation: implications for practice policy and research. Journal of clinical nursing, 19(11‐12), 1485-1494.

Alexandrou, Evan, Spencer, Tim, Frost, Steven A, Parr, Michael, Davidson, M, & Hillman, Ken M. (2010). Establishing a nurse-led central venous catheter insertion service. Journal of the Association for Vascular Access, 15(1), 21-27.

Yacopetti, Nic, Alexandrou, Evan, Spencer, Tim R, Frost, Steven A, Davidson, Patricia M, O'Sullivan, Greg, & Hillman, Ken M. (2010). Central venous catheter insertion by a clinical nurse consultant or anaesthetic medical staff: a single-centre observational study. Critical Care and Resuscitation, 12(2), 90.

Alexandrou, Evan, Ramjan, Lucie M, Spencer, Tim, Frost, Steven A, Salamonson, Yenna, Davidson, Patricia M, & Hillman, Ken M. (2011). The use of midline catheters in the adult acute care setting–clinical implications and recommendations for practice. Journal of the Association for Vascular Access, 16(1), 35-41.

Alexandrou, Evan, Murgo, Margherita, Calabria, Eda, Spencer, Timothy R, Carpen, Hailey, Brennan, Kathleen, Hillman, Ken M. (2012). Nurse-led central venous catheter insertion—Procedural characteristics and outcomes of three intensive care based catheter placement services. International journal of nursing studies, 49(2), 162-168.

Alexandrou, Evan, Ramjan, Lucie, Murphy, Jeff, Hunt, Leanne, Betihavas, Vasiliki, & Frost, Steven A. (2012). Training of undergraduate clinicians in vascular access: An integrative review. Journal of the Association for Vascular Access, 17(3), 146-158.

Alexandrou, E, Murgo, M, Calabria, E, Spencer, T, Carpen, H, Brennan, K, & Frost, S. (2012). Procedural characteristics and outcomes of three intensive care based, nurse-led catheter placement services. Australian Critical Care, 25(2), 120.

Alexandrou, Evan. (2013). Thesis: Towards best practice: procedural characteristics and outcomes of nurse-led central venous catheter insertion. Curtin University Retrieved from

Carr, Peter J, Alexandrou, Evan, Jackson, Gavin M, & Spencer, Timothy R. (2013). Assessing the quality of central venous catheter and peripherally inserted central catheter videos on the YouTube video-sharing web site. Journal of the Association for Vascular Access, 18(3), 177-182.

Alexandrou, Evan, Spencer, Timothy R, Frost, Steven A, Mifflin, Nicholas, Davidson, Patricia M, & Hillman, Ken M. (2014). Central Venous Catheter Placement by Advanced Practice Nurses Demonstrates Low Procedural Complication and Infection Rates—A Report From 13 Years of Service*. Critical Care Medicine, 42(3), 536-543.

Alexandrou, Evan. (2014). The One Million Global Catheters PIVC worldwide prevalence study. British journal of nursing (Mark Allen Publishing), 23(8 Suppl), S16-17.

Alexandrou, Evan. (2014). A Global Prevalence Study on Peripheral Catheters–The OMG PIVC Study. The Journal of the Association for Vascular Access, 19(4), 212.

Walker, Graham, Alexandrou, Evan, Rickard, Claire M, Chan, Raymond J, & Webster, Joan. (2015).

Effectiveness of electrocardiographic guidance in CVAD tip placement. British Journal of Nursing, 24(Sup14), S4-S12.

Alexandrou, Evan, Ray‐Barruel, Gillian, Carr, Peter J, Frost, Steven, Inwood, Sheila, Higgins, Niall, . . .

Rickard, Claire M. (2015). International prevalence of the use of peripheral intravenous catheters. Journal of hospital medicine, 10(8), 530-533.

Kabululu, E. K., Ray-Barruel, G., Alexandrou, E., & Rickard, C. M. (2015). One million global Catheters PIVC worldwide prevalence study: building alliances to put vascular access device management and infection prevention on the world stage from Australia to the Democratic Republic of Congo. Antimicrobial Resistance and Infection Control, 4(1), P204.

(2016). Chlorhexidine bathing and health care-associated infections among adult intensive care patients: a systematic review and meta-analysis. Critical Care, 20(1), 379..

Mifflin, N., Sou, V., Alexandrou, E., Stewart, A., & Catt, J. (2017). Paradoxical Electrocardiographic

Rhythm During Peripherally Inserted Central Catheter Insertion from Persistent Left Superior Vena Cava. Journal of the Association for Vascular Access, 22(1), 15-18.

Rickard, CM., Marsh, NM., Webster, J., …… Alexandrou, E., et al. (217). Peripherally InSertedCEntral catheter dressing and Securement: the PISCES Trial. Protocol for a 2x2 factorial, superiority randomised controlled trial. BMJ Open. 7(6),e015291.

Sou, V., McManus, C., Mifflin, N., Frost, S. A., Ale, J., & Alexandrou, E. (2017). A clinical pathway for the management of difficult venous access. BMC Nursing, 16(1), 64.

Alexandrou. E., Mifflin, N., McManus, C., Sou, V., & Frost, S.A. (2018).  Extended dwell peripheral catheters in patients with difficult venous access: Comparison of a peripheral intravenous catheter and midline catheter. Vascular Access, 4 (1), 1-5.

CIVA Media Releases:




25th October 2015

26th September 2016

Online Western Sydney University News Centre

Newspaper Interview: Liverpool Champion

Study unites medical staff across borders for global catheter audit

Excellent Evan is innovation king

23rd February 2016

28th June 2017

Radio Interview: ABC ‘the World Today’

Newspaper interview: Liverpool Champion

Home health care ‘cheaper and safer’

This hero doesn’t wear a cape

10th April 2018

Newspaper interview: The Sydney Morning Herald

20 to 1: New hospital program reduces number of failed IV insertion attempts

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